Risk factors for early death among extremely low-birth-weight infants
ABSTRACT The purposes of this study were to compare the clinical characteristics of extremely low birth-weight infants (501-1000 g birth weight) who die early (<12 hours of age) with those of infants who die >12 hours after birth and infants who survive to neonatal intensive care unit discharge and to develop a model of risk for early death.
Perinatal data were prospectively collected on 5986 infants in the 12 participating centers of the National Institute of Child Health and Human Development Neonatal Research Network from March 1993 through December 1997. Maternal and neonatal characteristics of infants who died early were compared with infants who survived and infants who died beyond 12 hours of age. A model for risk for early death was developed by logistic regression analysis, with results expressed as odds ratio with 95% CI.
Mothers of infants who died early were more likely to be delivered in an inborn setting and experience labor and were less likely to have hypertension or preeclampsia, to receive antenatal corticosteroids, or to be delivered by cesarean birth than mothers of infants who died >12 hours after birth or infants who survived. Infants who died early were more likely to have lower Apgar scores and lower gestational age/birth weight and were less likely to be intubated at birth and to receive mechanical ventilation and surfactant therapy than infants who died >12 hours after birth or infants who survived. Greater risk for early death versus survival to neonatal intensive care unit discharge was associated with the lack of surfactant administration (odds ratio, 8.6; 95% CI, 6.3-11.9), lack of delivery room intubation (odds ratio, 5.3; 95% CI, 3.5-8.1), lack of antenatal corticosteroid use (odds ratio, 2.3; 95% CI, 1.6-3.2), lower 1-minute Apgar score (odds ratio, 2.0; 95% CI, 1.8-2.2), male sex (odds ratio, 1.7; 95% CI, 1.3-2.3), multiple gestation (odds ratio, 1.7; 95% CI, 1.2-2.5), no tocolytics (odds ratio, 1.7; 95% CI, 1.2-2.3), lower gestational age per week (odds ratio, 1.4; 95% CI, 1.3-1.6), and lower birth weight per 50 g (95% CI, 1.2-1.4).
Early death (<12 hours of age) among extremely low-birth-weight infants may reflect an assessment of non-viability by obstetricians and neonatologists.
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ABSTRACT: Objective: To describe the incidence of extremely low birth weight infants and death triggering factors. Materials and methods: This is an observational, analytic, ambispective and comparative study. All extremely low birth weight infants born at the Hospital Universitario Dr. José Eleuterio González during the years 2003 and 2004 were included. Patients' medical records were retrieved and all patients were separated in two groups: A (alive) and B (dead). General morbimortality variables were analyzed; odds ratio was determined for those with statistical significance. Results: There were 81 patients with extremely low birth weight, with an incidence of 1.05% of the total births. When comparing both groups in relation with weight we found that group A (alive) the majority of infants with weight above 750 g survived (p < 0.001). In relation with gestational age of dead infants, close to 50% of them were younger than 28 weeks of gestational age (p < 0.01). There was no statistical significance when comparing delivery, gender, prenatal control, adolescent mother, use of prenatal steroids and surfactant. Comparing the morbidity between both groups, we found that among the infants who died, respiratory distress syndrome (RDS) was more prevalent and a higher degree of respiratory distress syndrome type 3 and 4 was present (p < 0.001), therefore the infants who died required more mechanical ventilation (p < 0.0001). Among the variables with higher odds ratio for dying (above 10) were: being less than 28 weeks of gestational age (RM: 11.6), weight at birth (RM: 10.9), mechanical ventilation (RM: 12.9) and respiratory distress syndrome (RM: 16.9). Perinatal asphyxia had an odds ratio of 3.5. Conclusion: The risk factors for dying are: prematurity < 28 weeks of gestational age, birth weight less than 750 grams, mechanical ventilation, RDS and perinatal asphyxia. Only 59% underwent adequate prenatal control, the lack of it being a bad prognostic factor in both groups.
Article: Morir en un Servicio de Neonatología